Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 5101020887 | MI |
Y | 2080P0203X | Pediatric Critical Care Doctor | 007183 | AZ |
NPI | 1023423720 |
---|---|
Provider Name | Matthew Carter |
First Address | Phoenix, AZ 85018-2327 |
Second Address | Phoenix, AZ 85016-7710 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2014 |
Last Update Date | 16/12/2020 |